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  "docSlug": "34401c2968d1",
  "documentTitle": "Dexcom, Inc. (DXCM)",
  "authorId": "54_Spruce_Point_Capital",
  "authorName": "Ben Axler",
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  "sourceTypeLabel": "Short seller",
  "presentationDate": "2019-03-21 00:00:00",
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  "notes": "Uses earnings call quotes to highlight a discrepancy between Abbott's reported progress and Dexcom's downplaying of the situation.",
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      "kind": "callout",
      "text": "Further, Dexcom seems to be downplaying Abbott’s recent traction with major payors.",
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      "kind": "callout",
      "text": "Abbott achieving Tier 2 status across 166 plans on one of the largest health insurers in the U.S. is NOT \"small scale\"",
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      "text": "Tier 2 coverage: 166",
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      "text": "The potentially high cost of the Dexcom to health insurance providers is driving insurers to incentivize patients to choose the Libre over the G-Series. In particular, Abbott is in the process of obtaining “preferred co-pay” status with major PBMs and insurers. Our diligence reveals that Abbott has obtained Tier 2 (preferred co-pay) status across almost all Anthem insurance plans (166 out of 168). By comparison, only 15 of 168 Anthem plans offer Tier 2 coverage on Dexcom CGMs. Tier 2 co-pays generally range from $15 to $50 versus Tier 3 co-pays that range from $50 to $150. We believe that the price difference between Libre and the G-Series gives insurers a vested interest in swaying diabetes patients to choose the Libre over Dexcom CGMs, and that the launch of the technologically-competitive Libre 2 could threaten Dexcom insurer reimbursement rates at its current price point.",
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      "kind": "quote",
      "text": "In the U.S., we saw an accelerating trend of new users as we ramped up our awareness efforts... Abbott Q4 FY18 Earnings Call",
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      "kind": "quote",
      "text": "There’s nothing of significance that we could point to in either direction... Dexcom Q4 FY18 Earnings Call",
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      "kind": "quote",
      "text": "\"In the U.S., we saw an accelerating trend of new users as we ramped up our awareness efforts during the second half of the year and pharmacy insurance coverage continued to increase including an emerging trend of seeing Libre granted preferred co-pay status versus competitive systems due to its compelling overall value proposition.\" — Abbott Q4 FY18 Earnings Call, \"There's nothing of significance that we could point to in either direction where we've been advantaged or any other competitor has been advantaged to our knowledge. So we hear rumblings of it here or there. Usually it's on a very small scale.\" — Dexcom Q4 FY18 Earnings Call",
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      "kind": "source-note",
      "text": "Source: Formulary Lookup",
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      "kind": "table",
      "text": "Case Study: Anthem, Inc. Coverage Comparison. Libre vs Dexcom tiers.",
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      "kind": "title",
      "text": "Insurers Are Incentivizing Patients To Choose The Lower-Cost Libre",
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